Candidacy and management of assistive listening devices: special needs of the elderly

Assistive Technology for Adults with Hearing Aids

Although there is a strong trend of satisfaction with hearing aids, recent consumer surveys indicate that there are still challenges with understanding speech in background noise and low penetration of wireless technologies using many modern-day communication and audio devices, such as smartphones, tablets, and computers. For some listening and communication settings, many patients could benefit from assistive technology that exceeds the capabilities of their hearing aids. When patients are not wearing their hearing aids, such as during sleep, concerns about environmental awareness and safety begin to arise. This article describes some current assistive technologies and accessories that facilitate accessibility to other devices and to satisfy the patient's listening and communication needs.

Benefits of incorporating the adaptive dynamic range optimization amplification scheme into an assistive listening device for people with mild or moderate hearing loss

This study investigated whether a self-designed assistive listening device (ALD) that incorporates an adaptive dynamic range optimization (ADRO) amplification strategy can surpass a commercially available monaurally worn linear ALD, SM100. Both subjective and objective measurements were implemented. Mandarin Hearing-In-Noise Test (MHINT) scores were the objective measurement, whereas participant satisfaction was the subjective measurement. The comparison was performed in a mixed design (i.e., subjects' hearing status being mild or moderate, quiet versus noisy, and linear versus ADRO scheme). The participants were two groups of hearing-impaired subjects, nine mild and eight moderate, respectively. The results of the ADRO system revealed a significant difference in the MHINT sentence reception threshold (SRT) in noisy environments between monaurally aided and unaided conditions, whereas the linear system did not. The benchmark results showed that the ADRO scheme is effectively beneficial to people who experience mild or moderate hearing loss in noisy environments. The satisfaction rating regarding overall speech quality indicated that the participants were satisfied with the speech quality of both ADRO and linear schemes in quiet environments, and they were more satisfied with ADRO than they with the linear scheme in noisy environments.

Systematic Review of the Effectiveness of Frequency Modulation Devices in Improving Academic Outcomes in Children With Auditory Processing Difficulties

This systematic review describes the published evidence related to the effectiveness of frequency modulation (FM) devices in improving academic outcomes in children with auditory processing difficulties. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were used to identify articles published between January 2003 and March 2014. The Cochrane Population, Intervention, Control, Outcome, Study Design approach and the American Occupational Therapy Association process forms were used to guide the article selection and evaluation process. Of the 83 articles screened, 7 matched the systematic review inclusion criteria. Findings were consistently positive, although limitations were identified. Results of this review indicate moderate support for the use of FM devices to improve children's ability to listen and attend in the classroom and mixed evidence to improve specific academic performance areas. FM technology should be considered for school-age children with auditory processing impairments who are receiving occupational therapy services to improve functioning in the school setting.

Usability of assistive listening devices by older adults with low vision

PURPOSE

This study examines the performance of individuals with both hearing and vision loss when using assistive listening devices.

METHODS

Older adults (age 60-100) with low vision only (n = 23), combined vision and hearing loss (n = 25) and a control group (n = 12) were asked to assemble a pocket talker, and operate a talking clock and an amplified telephone. They either received minimal or no instruction. Success at using the devices properly, as well as performance speed, was recorded.

RESULTS

The proportion of individuals with sensory loss that was able to complete our naturalistic tasks without mistakes ranged from 20% to 95%, depending on the device, the task complexity and the instruction provided. Both instruction as well as simple repetition had statistically significant and separate beneficial effects; however, neither was able to bring success to 100% on any device. Speed and task success were linked in an intuitive way, whereby individuals who succeeded at a task also performed it faster.

CONCLUSIONS

Even minimal explanation during the introduction of assistive listening devices to persons with low vision facilitates user success. Device visibility, cognitive and motor complexity of the task, as well as manual dexterity warrant further investigation as potential barriers to device use. Implications for Rehabilitation Hearing rehabilitation with individuals affected by vision loss requires additional attention and time to accommodate challenges with visibility and task complexity. Even minimal rehabilitation interventions can improve success and speed of device use. Repetition (practice) and instruction (strategy) have independent beneficial effects on device use. Dexterity, visibility, hand-eye-coordination, task complexity and cognitive ability need to be considered when assigning assistive devices for older adults with vision and/or hearing loss.

Rehabilitation of Older Adults With Hearing Impairment: A Critical Review

Objectives: Hearing impairment, which affects both peripheral and central structures of the auditory system, is highly prevalent among older adults and has serious consequences both for the people with hearing impairment and for those around them. This article provides an updated overview of the rehabilitation of this population. Methods: This article critically reviews the rehabilitation interventions available to older adults with hearing impairment: hearing aids, hearing assistance technology, and communication programs. Results: Current evidence suggests positive outcomes of similar magnitude for the three rehabilitation interventions, however their availability/uptake and adherence are suboptimal. Discussion: To improve the current situation, two changes to practice are warranted. First, availability of the range of rehabilitation interventions should be improved. Second, in accordance with the self-management of other chronic health conditions, older adults with hearing impairment should be invited to be actively involved in their rehabilitation.

Factors that influence the use of assistance technologies by older adults who have a hearing loss

The objective of this study was to describe and better understand the factors that influence the use of assistance technologies by older adults who have a hearing loss. We were interested in adopting a methodological approach that would provide an in-depth account of individual experiences related to the use of these technologies. A qualitative research design was therefore selected. Audio-recorded interviews were conducted with ten individuals who were 65 years of age or older and were current successful assistance technology users. Thematic analysis was used to draw meaning from the interview transcripts. The results suggest that successful use of these assistance technologies involves the recognition of hearing difficulties, an awareness that technological solutions exist, consultation for and acquisition of devices, and adapting to device use and modified behaviour. These four landmarks seem to be crucial stages when people either move toward successful assistance technology use or are discouraged from assistance technology use. Based on these results, a representative model of assistance technology awareness, acquisition and utilization is proposed.

Audiologic management of older adults with hearing loss and compromised cognitive/psychoacoustic auditory processing capabilities

The number and proportion of older adults in the United States population is increasing, and more clinical audiologists will be called upon to deliver hearing care to the approximately 35% to 50% of them who experience hearing difficulties. In recent years, the characteristics and sources of receptive communication difficulties in older individuals have been investigated by hearing scientists, cognitive psychologists, and audiologists. It is becoming increasingly apparent that cognitive compromises and psychoacoustic auditory processing disorders associated with aging may contribute to communication difficulties in this population. This paper presents an overview of best practices, based on our current knowledge base, for clinical management of older individuals with limitations in cognitive or psychoacoustic auditory processing capabilities, or both, that accompany aging.

A health policy for hearing impairment in older Australians: what should it include?

Background

As in all western countries, Australia's older population experiences high levels of hearing impairment coupled with relatively low levels of hearing device usage. Poor hearing diminishes the quality of life of affected individuals and their families. This paper discusses how to improve Australian hearing health policies in order to better combat this impairment amongst older Australians.

Method

We searched the databases Medline, Meditext and Web of Science to find articles that discussed strategies and innovations to assist the hearing health of older people, and related this material to observations made during the Blue Mountains Hearing Study in NSW between 1997 and 2003.

Results and Discussion

The literature search identified five areas for inclusion in a comprehensive hearing health policy in Australia. These are: early intervention; addressing of hearing aid expense; the use of assisted listening devices; hearing rehabilitation, and; screening and education. Further research in Australia is critical if we are to develop a strong approach to the increasing prevalence of age-related hearing loss.

Conclusion

Australia needs to act now to address hearing impairment as it is a major cause of disability in those aged 55 and over. Federal and State governments should collaborate to construct a comprehensive hearing health policy that tackles poor levels of hearing health through early intervention, addressing hearing aid expense, encouraging the use of assisted listening devices, rehabilitation, screening and education. A good start would be to declare age related hearing impairment as a National Health Priority Area.